Donovan, Maggie R.

Granulomatous inflammation is a rare but known filler-related complication that may present similarly to an active infectious process with pain, swelling, and erythema. This study describes hyaluronic acid filler-related delayed-onset nodule formation in a pair of 44-year-old and 56-year-old females who were ineffectively treated with numerous attempts of antibiotic regimens, incision and drainage (I&D) procedures, and low-dose hyaluronidase across several months despite multiple negative microbial cultures. After initiation of hyaluronidase therapy dosed to filler-related vascular occlusion guidelines, complete resolution of symptoms was achieved in both patients. These cases emphasize the relevance of considering delayed-onset nodules in the differential for filler complications that are culture-negative and unresponsive to antibiotic treatment and I&D. We propose complete dissolution with higher dosage hyaluronidase as a safe and effective treatment modality with respect to the current lack of defined guidelines for treating this complication.

AbstractObjectiveInvasive fungal sinusitis (IFS) in patients with active or recent COVID‐19 have been reported throughout the world. The primary purpose of the systematic review is to describe factors associated with IFS in patients with COVID‐19. The goal of the case series was to also characterize these factors in addition to evaluating the incidence of IFS at our institution after the onset of the pandemic.MethodsA systematic review using the preferred reporting in systematic reviews and meta‐analyses (PRISMA) framework identified publications of IFS cases associated with COVID‐19 (IFSAC). Search terms were “COVID‐19,” “invasive,” “fungal,” and “sinusitis.” IFS cases were evaluated for COVID‐19 status, fungal etiology, comorbidities, treatment, and outcome. A case series of patients at our center with IFS between December 1, 2018 to March 31, 2020 (“pre‐covid”) and April 1, 2020 to August 1, 2021 (“post‐covid”) was also performed with the above parameters.ResultsFourteen studies totaling 206 cases of IFSAC were identified. Most cases came from India (140/206, 68.0%), followed by Egypt (62/206, 30.1%), and North America (4/206, 1.9%). Diabetes was the most common comorbidity (151/206, 73.3%). Recent or prolonged steroid use was noted in 65.0% of cases (134/206). In our series, five pre‐covid and four post‐covid cases were identified. One had recent COVID‐19 infection. Acute myeloid leukemia was the most common pre‐covid comorbidity (3/5, 60.0%). Diabetes was the most frequent post‐covid comorbidity (2/4, 50.0%). Chronic steroid usage was noted in two pre‐covid and one post‐covid cases.ConclusionDiabetes and steroid use are common factors in reported cases of IFSAC. IFS incidence in our case series did not change appreciably after the onset of the pandemic.Level of Evidence: 4.